Increased Antifungal Antibodies in Bronchoalveolar Lavage Fluid and Serum in Pulmonary Sarcoidosis

Abstract

The recent studies suggest a role of fungi in development of sarcoidosis. Moreover, the immune response in sarcoidosis and fungal infection shows a striking similarity. We formulated a hypothesis of the possible increase in antifungal antibodies in bronchoalveolar lavage fluid (BALF) and serum in pulmonary sarcoidosis. BALF and serum levels of IgG-, IgM- and IgA-specific antibodies against the cell wall β-D-glucan and mannan of Candida albicans and Saccharomyces cerevisiae were tested in 47 patients (29 pulmonary sarcoidosis patients and 18 patients with other interstitial lung diseases (ILD - control group)) and 170 healthy controls. Our results proved: (1) an increase in IgG-, IgM- and IgA-specific antifungal antibodies in BALF in pulmonary sarcoidosis compared with the control group (C. albicans: IgG: P = 0.0329, IgM: P = 0.0076, IgA: P = 0.0156; S. cerevisiae: IgG: P = 0.0062, IgM: P = 0.0367, IgA: P = 0.0095) and (2) elevated levels of serum antifungal antibodies in pulmonary sarcoidosis compared with healthy controls (C. albicans: IgG: P = 0.0329, IgM: P = 0.0076, IgA: P = 0.0156; S. cerevisiae: IgG: P > 0.05, IgM: P < 0.05, IgA: P < 0.001). The study showed increased serum and BALF levels of antifungal antibodies in pulmonary sarcoidosis. The hypothesis that fungal infection is one of the possible aetiologic agents of sarcoidosis is interesting and deserves further attention.

Is there any association between Sarcoidosis and infectious agents?: a systematic review and meta-analysis

“…Currently, the focus is on infectious agents, especially species of Mycobacterium and Propionibacterium . Other infectious agents have been investigated with inconclusive or conflicting results, such as Borrelia burgdorferi , Rickettsia helvetica, Chlamydia pneumoniae , viruses, fungal infections, and Leishmania species [3–11]. …”

Microbial Lineages in Sarcoidosis. A Metagenomic Analysis Tailored for Low–Microbial Content Samples

“…Granulomatous inflammation is commonly seen in responses to microbial agents, as are other features of sarcoidosis immunopathology, such as oligoclonal CD4 T-cell expansion and T-helper cell type 1 polarization (1). No microbial cause has been definitively established for sarcoidosis, but candidates include species of Mycobacterium (6)(7)(8)(9), as well as fungi (10) and Propionibacterium acnes (11,12), a common skin bacteria.…”

A Case of Chronic Cough in a Winemaker

“…An increase in S. cerevisiae antibodies has been found in individuals with pulmonary sarcoidosis as well as interstitial lung disease. It is believed fungal pathogens can survive in immunocompetent patients via the formation of biofilms, establishing a relationship between fungi and the hosts [13]. Our patient had no evidence of either condition.…”